ASC April Update Brings New Codes, Pay Rates

The Centers for Medicare & Medicaid Services (CMS) released on March 16 the April 2012 update of the ambulatory surgical center payment system (ASC PS). This update implements ASC quality measures, new payment rates, and expanded billing instructions for certain new HCPCS Level II codes that pertain to ASCs; and is in addition to payment policy changes and billing instructions implemented in the April 2012 update of the Outpatient Prospective Payment System (OPPS), released March 2.

New HCPCS Level II Codes

CMS introduced four new HCPCS Level II codes for drugs and biologicals in the April 2012 update of the OPPS. The codes are C9288 Injection, centruroides (scorpion) immune f(ab)2 (equine), 1 vial, C9289 Injection, asparaginase erwinia chrysanthemi, 1,000 international units (I.U), C9290 Injection, bupivicaine liposome, 1 mg, and C9291 Injection, aflibercept, 2 mg vial. These codes are separately payable under the ASC PS effective April 1, 2012.

In the April 2012 update of the ASC PS, CMS expands on billing instructions for C9291 to clarify that payment is for the entire contents of the single-use vial, which is labeled as providing a 2 mg dose.

The U.S. Food and Drug Administration (FDA) approved aflibercept ophthalmic solution (Eylea) on Nov. 18, 2011 for the treatment of neovascular (“wet”) age-related macular degeneration (AMD). This product is also marketed as ZALTRAP^®.

New Pay Rates

The payment rates for certain HCPCS Level II codes were incorrect in the July and October 2011 ASC DRUG files. The codes and corrected payments are:

ASC Quality Measures

In the 2012 OPPS/ASC Final Rule (CMS-1525-FC), CMS established a quality reporting program for ASCs and adopted five quality measures, including four outcome measures and one surgical infection control measure beginning in 2012 for the 2014 payment determination. See CMS Transmittal 2425, Table 6, for ASC quality measures and corresponding HCPCS Level II codes.

ASCs may begin to report these quality measures on submitted ASC facility claims beginning with dates of service on or after April 1, 2012.

See CMS Transmittal 2425, Change Request (CR) 7754, issued March 16, for complete details of this April 2012 update of the ASC PS.

March 29th, 2012

No Comments

April OPPS Additions, Changes, Deletions

The Centers for Medicare & Medicaid Services (CMS) has posted April 2012 changes to billing instructions for payment policies implemented in the hospital Outpatient Prospective Payment System (OPPS). The April 2012 updated Integrated Outpatient Code Editor (I/OCE) and OPPS Pricer will reflect the HCPCS Level II, ambulatory payment classification (APC), HCPCS modifier, and revenue code additions, changes, and deletions as identified in change request (CR) 7748. The April 2012 revisions to I/OCE data files, instructions, and specifications are provided in CR 7751, “April 2012 Integrated Outpatient Code Editor (I/OCE) Specifications Version 13.1.”

Noteworthy Changes

1. For services provided on or after Jan. 1, 2012, the descriptor for CPT® 33249 has been changed to read “Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber.” Due to clinical inappropriateness, this has prompted the removal of HCPCS Level II code C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable) from the list of device codes required to be billed with CPT® code 33249 on the procedure-to-device edit list. This change is retroactive to Jan. 1, 2012.

2. For new service (fluorescent vascular angiography), HCPCS Level II code C9733 Non-ophthalmic fluorescent vascular angiography (SI = Q2 and APC = 0397, vascular imaging) is assigned for $154.87 payment (minimum unadjusted copayment = $30.98) under the OPPS, effective April 1, 2012. HCPCS Level II code C9733, assigned to APC 0397, describes SPY® Fluorescence Vascular Angiography and other types of non-ophthalmic fluorescent vascular angiography.

3. Drugs and biologicals with OPPS pass-through status, effective April 1, 2012, are:

C9288 Injection, centruroides (scorpion) immune f(ab)2 (equine), 1 vial

C9289 Injection, asparaginase Erwinia chrysanthemi, 1,000 international units (I.U.)

C9290 Injection, bupivacaine liposome, 1 mg

C9291 Injection, aflibercept, 2 mg vial

4. Payment rates for certain HCPCS Level II codes effective July 1- Sept. 30, 2011 are:

5. The following HCPCS Level II codes describe products that can be used as skin substitutes (They will be separately paid only when used with one of the CPT® codes describing the application of a skin substitute (15271-15278)):

For the complete CR, see CMS Transmittal 2418.

March 16th, 2012

1 Comment